Safe Churches
Ministry at the Beginning of the 21st Century
Policies for the
Protection of Children and Youth
from Abuse
Diocese of Central Florida
Adapted from the Model Policies developed by
THE CHURCH PENSION GROUP
and
Developed in Partnership with
The Nathan Network
As Revised & Adopted, October 13, 2005
Table of Contents
Introduction and History of these policies........................................................................................... 5
Acknowledgments and Disclaimer...................................................................................................... 7
I. Code of Conduct for Protection of Children and Youth.................................................................. 9
II. General Definitions...................................................................................................................... 10
A. Church Personnel........................................................................................................... 10
B. Children and youth......................................................................................................... 10
C. “Regularly” or “Occasionally” Work With or Around Children or Youth........................... 10
D. Types of abuse.............................................................................................................. 12
III. Safeguards for Children and Youth............................................................................................. 12
A. Screening and Selection................................................................................................. 12
B. Education and Training Requirements.............................................................................. 13
C. Monitoring and Supervision of Programs........................................................................ 14
D. General Conduct for the Protection of Children and Youth.............................................. 15
IV. Responding to Problems............................................................................................................ 17
A. Reporting of Inappropriate Behaviors or Policy Violations with Children or Youth....... 17
B. Reporting of Suspected Abuse of Children or Youth....................................................... 17
Appendix A. Guidelines for Appropriate Affection........................................................................... 19
Appendix B. Confidential Notice of Concern................................................................................... 21
Appendix C. Sample Application Form, Code of Conduct, Acknowledgment, and Release.............. 23
Appendix D. Key Assignment Agreement........................................................................................ 26
Appendix E. State Child Abuse Reporting Statute Summary and Pertinent Text................................ 27
Appendix F. House of Bishops Pastoral Letter on Child Sexual Abuse 2003.................................... 31
Appendix G. Resolution B008, Protection of Children and Youth From Abuse................................ 34
Introduction
The Diocese of Central Florida has had a long-standing commitment to protecting our children. Even before the Church, through the Church Insurance Company, mandated training designed to help prevent Child Sexual Abuse the Diocese was providing this training. We have been active in promoting healthy and healing practices not only because we think it prudent to exercise due diligence but also because God calls us to care for these little ones. It is the right and proper thing to do.
The following policies come out of many years of work within the Episcopal Church at every level. The majority of what follows comes to us from the Church Pension Group, in partnership with The Nathan Network, which has provided Model Policies for the Protection of Children and Youth from Abuse to the Episcopal Church.
These policies should be adapted by the congregation, school or church related institution to provide comparable standards and training for outside groups who make use of the facilities of the church, school, or institution. Written certification from these groups shall be done on an annual basis and kept on file by the church, school or institution.
History of these Policies for the Protection of Children and Youth from Abuse
The Committee on Sexual Exploitation ("COSE") was created by resolution of the 70th General Convention in 1991 to address issues of sexual misconduct in the Episcopal Church and has continued its work through the 74th General Convention in 2003. In 1999 in preparation for the 73rd General Convention in 2000, it conducted a survey of 100% of the domestic dioceses on how dioceses were dealing with issues of sexual misconduct. The survey indicated, among other things, that a conference for those who work on issues of sexual misconduct in the church was needed.
As a result, in June 2001 COSE and the Office of Pastoral Development sponsored the first national Pastoral Standards Conference. An extraordinary gathering of one hundred twenty-five bishops, chancellors, clergy and laity from 70 dioceses attended and unanimously called for review of existing sexual misconduct policies and development of the "next generation" of policies.
COSE gathered and reviewed policies submitted by 70 dioceses with the intention of circulating as model policies those that incorporated and reflected current best practices based on the Church's experience in the area of sexual misconduct over the past decade. COSE concluded that none of the policies gathered was a truly state-of-the-art, "next generation" policy that could serve as a model for those dioceses planning on revising and updating their current policies. COSE determined that it did not have the time or resources to create new state-of-the-art, next generation policies.
Encouraged to do so by COSE, with requests from a number of dioceses to do so, to support prevention efforts, and based on its own perception of the need, The Church Pension Group undertook to develop model child sexual abuse prevention and response policies.
Just prior to the meeting of the House of Bishops in March 2003, 47 bishops attended a training session on "What Every Bishop Should Know About Pedophiles and Preventing Child Sexual Abuse in the Church" put on by the Office of Pastoral Development and The Church Pension Group. Out of this training session came a Mind of the House Resolution presented by the 47 bishops in attendance that was approved unanimously by the House of Bishops.
Among other resolves, the resolution called for development of a statement of general expectations of behavior in this church by clergy, lay employees, and volunteers, when engaged in ministry with children and youth. The resolution stated that these expectations should be specific enough to serve as clear directions and guidelines, but general enough that each diocese would expand upon or develop the specific content of policies and procedures and implementation according to the particularities of each diocese. The Bishops unanimously committed to reviewing current diocesan policies, and revising them as needed. In addition, the Bishops committed to working together to provide appropriate training, education, and materials to support each diocese in the five identified areas.
The Bishops also committed to putting forth a resolution to the 74th General Convention in 2003 as the statement of general expectations called for by the March 2003 House of Bishops Mind of the House Resolution. Resolution B008, Protection of Children and Youth from Abuse, was submitted and passed at that General Convention.
[This History section was drawn, in large part, from the Explanation section of Resolution B008 as submitted to the 74th General Convention in 2003]
Children’s Charter and Safe Church Ministry at the Beginning of the 21st Century
Resolution B008 and these Model Policies for the Protection of Children and Youth from Abuse call the church to respond in new and intentional ways to care for, be responsible to, and create safe space for children. Foundational to Resolution B008 and the work of the Church Pension Group’s partnership with The Nathan Network is the Children’s Charter for the Church (General Convention Resolutions 1997- B005 and 2000 – D045). The Children’s Charter holds advocacy for children as central to the mission and ministry of the church. The Charter calls the Church to love, shelter, protect, and defend children within its own community and in the world, especially those who are abused, neglected, or in danger.
These
policies were adopted by the Diocesan Board, Diocese of Central Florida, October
13, 2005.
Acknowledgments
These Policies for the Protection of Children and Youth from Abuse were written in response to those expressing a need for updated or revised child sexual abuse policies based on the Church’s experience with these issues over the past decade. Nearly two years in development, these Policies have evolved through several iterations before taking their current form.
Principal author, Dr. Monica Applewhite, is President of Religious Services for Praesidium, Inc., a Texas consulting firm specializing in the development of policies and training materials for the prevention of child sexual abuse in organizational settings.
Sally Johnson, Vice President- Risk Management and Education headed up the project team at The Church Pension Group responsible for the development of these Policies.
Many groups in the Church reviewed drafts or responded to presentations about the content of various iterations of these Policies and we are grateful for their candid and thoughtful feedback and suggestions. These included The Nathan Network Steering Committee, the national Committee on Sexual Exploitation, the Bishops and Chancellors of Province I, the Bishops and Chancellors of Province IV, the Western Chancellors, the 2003 Conference of Diocesan Administrators, the 2003 Business Management Institute, the Office of Pastoral Development of the House of Bishops. Inclusion of a group in the Acknowledgements does not imply the group’s endorsement, approval, or any other action regarding these Policies; it simply acknowledges their participation and contributions to the development process.
Disclaimer
The Diocese of Central Florida and Church Pension Group provide these Policies for the Protection of Children and Youth from Abuse in partnership with the Nathan Network, in the hope that they may assist dioceses, congregations, and other Episcopal entities in developing policies for the prevention of child sexual abuse in ministries and church activities for children and youth. They are intended as a guide, not a manual. They do not cover every issue that you may want to consider in the development of such policies. Nor do they necessarily reflect in every aspect the laws of the State of Florida. The Diocese of Central Florida, the Church Pension Group and The Nathan Network are not engaged in giving legal or other professional advice or services by providing these Policies.
Relationships among people are at the foundation of Christian ministry and as such are central to the life of the church. Defining healthy and safe relationships through policies and codes of conduct is not meant, in any way, to undermine the strength and importance of personal interaction in our ministries. Rather, it is to assist in more clearly defining behaviors and practices that allow the church to more fully demonstrate its love and compassion for children and youth in sincere and genuine relationships.
Relationships in ministry should, ideally, always be experienced as caring and without intention to do harm or allow harm to occur. This Code of Conduct has been adopted by the Diocese of Central Florida to help the church create safe environments for children and youth and for those who minister to them. All Church Personnel are asked to carefully consider each statement in the Code and within the Policies for the Protection of Children and Youth from Abuse before agreeing to adhere to the statements and continue in service to the church.
Code of Conduct for Protection of Children and Youth
Church Personnel understand that the church will not tolerate abuse of children and youth and agree to comply in spirit and in action with this position.
Church Personnel agree to do their best to prevent abuse and neglect among children and youth involved in church activities and services.
Church Personnel agree to not physically, sexually or emotionally abuse or neglect a child or youth.
Church Personnel agree to comply with the policies for general conduct with children and youth as defined in the Policies for the Protection of Children and Youth from Abuse.
All Church Personnel agree to comply with the Guidelines for Appropriate Affection with children and youth.
In the event that Church Personnel observe any inappropriate behaviors or possible policy violations with children or youth, Church Personnel agree to immediately report their observations.
All Church Personnel acknowledge their obligation and responsibility to protect children and youth and agree to report known or suspected abuse of children or youth to appropriate church leaders and state authorities in accordance with these policies.
Please reference Section IV A and B.
For the purposes of this policy, the following are included in the definition of Church Personnel when they are functioning in their respective roles for the church:
1. All clergy whether stipendiary, non-stipendiary, or otherwise who are engaged in ministry or service to the church.
2. All paid personnel whether employed in areas of ministry or other kinds of services by the diocese, its congregations, schools or other agencies. For example, sexton, secretaries, youth minister, choir director, Christian Education Directors, school personnel.
3. Those who contract their services to the diocese, its congregations, schools or other agencies and that have regular access to children or the facilities.
4. Volunteers, including any person who enters into or offers him or herself for a church related service, or who actually assists with or performs a service, whether or not they have been selected or assigned to do so. Volunteers include members of advisory boards, vestries, Bishop’s Committees, boards of directors, Sunday school teachers, nursery attendants, acolyte leaders, youth leaders, etc.
A child is defined as anyone under the age of 12 years.
A youth is defined as anyone who is at least 12 years old, but not yet 18 years old. A youth may also be an individual who is 18 years old or older, but still in high school.
1. All clergy whether stipendiary, non-stipendiary, or otherwise who are engaged in ministry or service to the church.
2. All paid Church Personnel whose work regularly takes them throughout the facility or grounds or who has keys giving them access to the buildings on the grounds.
3. All volunteers who have keys giving them access to the buildings on the grounds except those who only occasionally access the buildings when little interaction with children or youth is likely (for example persons serving on the altar guild or flower guild).
4. All persons who supervise or assist with supervising children or youth, in ministries, programs or activities more often than occasionally, including church school teachers.
5. All persons who provide transportation to children or youth more often than occasionally.
6. Any paid personnel whose living quarters are on the grounds of the church, school or other related agency.
7. All vestry members or other members of similar decision-making groups elected or appointed after December 31, 2005 who have the authority to approve the creation of ministries, programs or activities for children or youth.
Examples include, but are not limited to:
· Children’s or youth choir directors
· Organists who work with children or youth
· Lay youth ministers
· Volunteer youth directors
· All Church Personnel who work or assist in the nursery more than three times a year
· All adult Church Personnel who work in the nursery
· All staff, whether volunteer or paid, at church camps
· Adults who participate in overnight activities with children or youth
1. All persons who supervise or assist with supervising children or youth in ministries, programs or activities infrequently, generally no more than three times a year or for one program or activity during a year that lasts less than a month (i.e. assisting with preparation for the Christmas pageant, or teaching one “unit” of Church School for a month).
2. All persons who provide transportation to children or youth infrequently, generally no more than three times a year.
3. All persons who work or assist in the nursery three or fewer times a year, whether on an emergency basis or otherwise.
1. Physical abuse is non-accidental injury, which is intentionally inflicted upon a child or youth.
2. Sexual abuse is any contact or activity of a sexual nature that occurs between a child or youth and an adult. This includes any activity, which is meant to arouse or gratify the sexual desires of the adult, child or youth.
3. Emotional abuse is mental or emotional injury to a child or youth that results in an observable and material impairment in the child or youth’s growth, development or psychological functioning.
4. Neglect is the failure to provide for a child or youth’s basic needs or the failure to protect a child or youth from harm.
5. Economic exploitation is the deliberate misplacement, exploitation, or wrongful temporary or permanent use of a child or youth’s belongings or money.
6. Unwanted Sexual Activity is any contact or activity of a sexual nature that occurs between children, youth, or child/youth
1. Any and all Church Personnel who Regularly Work With or Around Children/Youth shall be screened and selected utilizing at least the following:
a. A standard application completed by the applicant that includes an authorization for the release of information to conduct background checks and the Code of Conduct (Appendix C).
b. Criminal records check in any state where the applicant has resided during the past seven (7) years, and other states, if any, as determined by the church.
c. Sexual offender and predator registry check in any state where the applicant has resided during the past seven (7) years.
d. Individual interview with the applicant.
e. Reference Checks of persons outside the congregation who know the applicant, preferably who know how the applicant works with children.
f. Driving or motor vehicle records check if the person may be transporting children or youth.
g. The above shall be initiated prior to the start of service.
2. Any and all Church Personnel who Occasionally Work With or Around Children or Youth shall be screened and selected utilizing at least the following:
a. A standard application completed by the applicant that includes a release of information to conduct background checks and the Code of Conduct (Appendix C).
b. Individual interview with the applicant.
c. At least one Reference Check of a person or persons outside the congregation who know the applicant, preferably who know how the applicant interacts with children.
d. Driving or motor vehicle records check if the person will be transporting children or youth.
e. Sexual offender and predator registry check in any state where the applicant has resided during the past seven (7) years.
f. The above shall be initiated prior to the start of service
3. All information gathered about an applicant will be carefully reviewed and evaluated to make a determination, in consultation with others as necessary, of whether or not the person is appropriate to work with children or youth.
4. Church Personnel who work with or around children or youth must have a personnel file that is kept where other church records are kept.
5. Criminal records checks and sexual offender and predator registry checks will be conducted every seven (7) years for Church Personnel who Regularly Work With or Around Children or Youth.
6. To the extent possible, no person will be permitted to supervise an immediate family member without other adults present when working with or around children or youth. For the purpose of this policy, immediate family member is defined as spouse, child, parent, sister, brother, similar in-law relationship, stepchild, stepparent, stepsibling, or grandparent.
7. Church Personnel who transfer within the Diocese of Central Florida and apply for or are asked to or who do undertake positions working with or around children are required to undergo the same screening and selection process in Section A above. This requirement may be met through a transfer of a copy of the personnel file to the new congregation, school, agency, or program together with completion of a new application, individual interview and reference checks with the congregations, schools, agencies or other programs for which the applicant has worked with or around children since the screening was last done as shown in the applicant’s personnel file.
1. Three hours of child abuse prevention education and training is required for all Church Personnel who Regularly Work With or Around Children or Youth before they start their work with children or youth or, if that is not possible, one hour of child abuse awareness training before they start their work and the rest of the training within three months of starting.
2. One hour of child abuse awareness education and training is required for all Church Personnel who Occasionally Work With or Around Children or Youth before they start their work with children or youth or at least within three months of starting.
The monitoring and supervision of programs and activities involving children or youth is important for safeguarding children and youth and involves several aspects. One aspect involves having structural guidelines or standards for the programs and activities for children and youth. These include such things as who approves new programs, how many adults need to be present and the like. In addition to setting structural guidelines and standards, church leaders must make sure the structural safeguards are followed. Programs and activities have to be monitored and supervised to do that.
Another aspect of monitoring and supervision is that supervisory personnel and others monitor and supervise the behavior of adults, youth and other children with children and youth so that inappropriate behaviors and interactions can be detected and stopped. Some behaviors and interactions are potentially harmful to children or youth in and of themselves. Examples include providing alcohol or drugs to children or youth or actually having sexual contact with a child or youth. Other behaviors and interactions are not necessarily harmful in and of themselves but are the same behaviors and interactions known to be used by those who abuse children or youth to “groom” them or their parents for eventual abuse or which provide the privacy child molesters need in order to abuse children or youth. Examples of those behaviors and interactions include holding children over the age of three on the lap, transporting a child or youth alone, and the like.
The structural standards guidelines and standards are covered in both the following Monitoring and Supervision section and in the following section, General Conduct for the Protection of Children and Youth.
The behaviors and interactions of persons with children and youth that need to be monitored and supervised are covered in the section on General Conduct for the Protection of Children and Youth and in the Guidelines for Appropriate Affection.
Every program for children and youth must have established ratios for adults and children established by the Diocesan Board (for diocesan activities), Vestry (for congregational activities), or by the Board of a church related institution. Compliance with the established ratio is required at all times, including activities that occur off church premises. Recommended guidelines follow:
The following guidelines are intended to assist Church Personnel in monitoring and supervising behaviors and interactions with children and youth in order to identify and stop those that may be inherently harmful to children or youth, which are the type used by child molesters to “groom” children, youth and their parents, or which may create the conditions where abuse can occur more easily. They are also used to make decisions about interactions with children and youth in church sponsored and affiliated programs. They are not designed or intended to address interactions within families. When exceptions to these guidelines must be made, they will be reported to the supervisor of the person granting the exception as soon as possible.
1. All Church Personnel who work with children and youth must agree to comply with these Guidelines for Appropriate Affection (Appendix A).
2. No person will be allowed to volunteer to regularly work with children or youth until the person has been known to the clergy and congregation for at least six months.
3. Programs for infants and children under six (6) years old will have procedures to ensure that children are released only to their parents or legal guardians or those designated by them.
4. Church Personnel are prohibited from the use, possession, distribution, or being under the influence of alcohol, illegal drugs, or the mis-use of legal drugs while participating in or assisting with programs or activities for children and youth.
5. Parents or guardians must complete written permission forms before Church Personnel transport children and youth for a church sponsored activity or for any purpose on more than an occasional basis.
6. Church Personnel will respond to children and youth with respect, consideration and equal treatment, regardless of sex, race, religion, sexual orientation, culture or socio-economic status. Church Personnel will portray a positive role model for children and youth by maintaining an attitude of respect, patience, and maturity. They will avoid even the appearance of favoritism.
7. One to one counseling with children and youth will be done in an open or public or other place where private conversations are possible but occur in full view of others.
8. Church Personnel are prohibited from dating or becoming romantically involved with a child or youth.
9. Church Personnel are prohibited from having sexual contact with a child or youth.
10. Church Personnel are prohibited from possessing any sexually oriented materials (magazines, cards, videos, films, clothing etc.) on church property or in the presence of children and youth except as expressly permitted as part of a pre-authorized educational program.
11. Church Personnel are prohibited from using the Internet to view or download any sexually oriented materials on church property or in the presence of children and youth.
12. Church Personnel are prohibited from discussing their own sexual activities, including dreams and fantasies, or discussing their use of sexually oriented or explicit materials such as pornography, videos or materials on or from the Internet, with children or youth.
13. Church Personnel are prohibited from sleeping in the same beds or sleeping bags with children or youth unless the adult is an immediate family member of all children or youth in the bed or sleeping bag. It is acceptable to have multiple adults sleep with all the children or youth participating in one open space such as a church basement or camp lodge.
14. Church Personnel are prohibited from dressing, undressing, bathing, or showering in the presence of children or youth.
15. Church Personnel are prohibited from using physical punishment in any way for behavior management of children and youth. No form of physical discipline is acceptable. This prohibition includes spanking, slapping, pinching, hitting, or any other physical force. Physical force may only be used to stop a behavior that may cause immediate harm to the individual or to a child, youth or others.
16. Church Personnel are prohibited from using harsh language, degrading punishment, or mechanical restraint such as rope or tape for behavior management.
17. Church Personnel are prohibited from participating in or allowing others to conduct any hazing activities relating to children’s or youth ministry or camp activities.
1. When Church Personnel observe any inappropriate behaviors, behaviors that are inconsistent with the Guidelines for Appropriate Affection, or which may violate any provision of the Policies for Protection of Children and Youth from Abuse, they must immediately report their observations. Examples of inappropriate behaviors or policy violations would be seeking private time with children or youth, taking children or youth on over-night trips without other adults, swearing or making suggestive comments to children or youth, or selecting staff or volunteers without the required screening.
2. Such inappropriate behaviors or possible policy violations that relate to interactions with children or youth should be reported as follows:
a. A telephone call or meeting with the immediate supervisor of the person and the rector,
b. A telephone call or meeting with a church warden if the person is the rector;
c. A telephone call, meeting or written notice to the Bishop or Canon to the Ordinary;
d. Submit a Notice of Concern (Appendix B) to the Immediate Supervisor, Rector and the Bishop.
3. All reports of inappropriate behavior or policy violations with children or youth will be taken seriously.
1. All Church Personnel are required by this policy to report known or suspected abuse of children or youth to the appropriate state authorities and to the Rector. (Appendix E)
2. Failure to report suspected abuse of children or youth is a crime. Reports may be made confidentially or anonymously. The State of Florida provides immunity from civil liability for persons required to report suspected abuse in good faith and without malice. Simply stated, “in good faith” means that the person submitting the report believes what he or she is reporting to be true.
3. In addition to reporting to the state authorities, Church Personnel are required to report any suspected or known abuse of children or youth that may have been perpetrated by Church Personnel directly to the rector of their Parish so that immediate and proper steps may be taken to ensure the safety of alleged victims.
4. Reports of suspected or known abuse that involve Church Personnel may be reported to the Diocese of Central Florida in the following ways:
a. A telephone call, meeting or written notice to the Bishop or Canon to the Ordinary;
b. A telephone call or meeting with the rector, if the member of the clergy is not the person being complained about.
5. The Diocese of Central Florida and all of our congregations and institutions will cooperate with any investigation by state authorities to the fullest extent appropriate and inform authorities that a concurrent internal investigation will be directed by the Diocese of Central Florida.
The Diocese of Central Florida is committed to creating and promoting a positive, nurturing environment for our children’s and youth ministries that protect our children and youth from abuse and our Church Personnel from misunderstandings. When creating safe boundaries for children and youth, it is important to establish what types of affection are appropriate and inappropriate, otherwise that decision is left to each individual. Stating which behaviors are appropriate and inappropriate allows Church Personnel to comfortably show positive affection in ministry, and yet identify individuals who are not maintaining safe boundaries with children and youth. The Guidelines are based, in large part, on avoiding behaviors known to be used by child molesters to “groom” children, youth, and their parents for future abuse. The following guidelines are to be carefully followed by all Church Personnel working around or with children and youth.
1. Love and affection are part of church life and ministry. There are many ways to demonstrate affection while maintaining positive and safe boundaries with children and youth. Some positive and appropriate forms of affection are listed below:
§ Brief hugs.
§ Pats on the shoulder or back.
§ Handshakes.
§ “High-fives” and hand slapping.
§ Verbal praise.
§ Touching hands, faces, shoulders and arms of children or youth.
§ Arms around shoulders.
§ Holding hands while walking with small children.
§ Sitting beside small children.
§ Kneeling or bending down for hugs with small children.
§ Holding hands during prayer.
§ Pats on the head when culturally appropriate. (For example, this gesture should typically be avoided in some Asian communities).
2. The following forms of affection are considered inappropriate with children and youth in ministry setting because many of them are the behaviors that child molesters use to “groom” children or youth for later molestation or can be, in and of themselves, sexual abuse.
§ Inappropriate or lengthy embraces.
§ Kisses on the mouth.
§ Holding children over three years old on the lap.
§ Touching bottoms, chests or genital areas other than for appropriate diapering or toileting of infants and toddlers.
§ Showing affection in isolated areas such as bedrooms, closets, staff only areas or other private rooms.
§ Occupying a bed with a child or youth
§ Touching knees or legs of children or youth.
§ Wrestling with children or youth.
§ Tickling children or youth.
§ Piggyback rides.
§ Hugs from behind.
§ Any type of massage given by a child or youth to an adult.
§ Any type of massage given by an adult to a child or youth.
§ Any form of unwanted affection.
§ Comments or compliments (spoken, written, or electronic) that relate to physique or body development. Examples would be, “You sure are developing,” or “You look really hot in those jeans.”
§ Snapping bras or giving “wedgies” or similar touch of underwear whether or not it is covered by other clothing.
§ Giving gifts or money to individual children or youth.
§ Private meals with individual children or youth in non public places.
Individual(s) of Concern __________________________________________________________________
Date of occurrence ___________ Time of occurrence: ______________________
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Type of Concern: |
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_____ Inappropriate behavior with a child or youth |
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_____ Policy violation with a child or youth |
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_____ Possible risk of abuse |
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_____ Other concern: ______________________________________________________________________ |
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Describe the situation: What happened, where it happened, when it happened, who was involved, who was present, who was notified? If reported to the State, what was their recommendation about investigating?
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Has this situation ever occurred previously? ________________________________________________
What action was taken? How was the situation handled, who was involved, who was questioned, were police called? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
What is the follow-up plan? Does anyone else need to be notified? Will the situation need monitoring? Would you like someone to call you to discuss this situation?
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Submitted by: ______________________________________ Telephone number____________________
Location and address: _____________________________________________________________________
Signature: ________________________________________ Date: _______________________________
Submitted to: _____________________________________ Date: _______________________________
Reviewed by: ____________________________________ Date: _______________________________
Appendix C: Sample Application Form, Code of Conduct, and Acknowledgment, Release and Signature
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Name: ________________________________________
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Street address: _____________________________ |
Driver License: State ____ Number__________________________ |
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City: __________________________ State: ______ Zip: _________ |
How long at current address: _____________ |
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Phone: Home (______) _______________________ |
Work (______) _______________________ |
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Best Time to Contact You: _______________________ |
E-Mail Address: __________________________________________ |
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Are you legally eligible to work in this country? ____ Yes ____ No |
Note: If you are chosen for a paid position, you will be required to show documents verifying your employment eligibility and identity to complete the INS Form I-9 as required by the Immigration Reform and Control Act.
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Please list your addresses in the past five years: |
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For what position are you applying? ___________________________________________________________________________ What interests you about the position for which you are currently applying? ___________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ |
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What has prepared you for the position for which you are currently applying? _________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ |
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Employment history- Please complete for your prior employers, covering the past ten years. |
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Dates of employment (Start with most recent) |
Company name and address (City, State Zip) |
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